Healthy Activities for Prize Incentives (HAPI)

描述(由申请人提供)：应急管理(CM)干预措施在提高治疗中的保留率和减少药物使用方面非常有效。越来越多的证据表明，这些治疗方法可以改变各种行为，包括与健康相关的体育活动。体育锻炼对减轻抑郁和改善健康有好处。我们有试点数据表明，与那些在中医治疗期间不参加锻炼的药物滥用患者相比，从事锻炼以获得强化的药物滥用患者的药物滥用结果有所改善。在这个第一阶段的治疗开发项目中，我们计划开发、正式化并推导出侧重于改善健康的CM治疗的效果大小估计，特别是与增加低强度体力活动有关的治疗，如步行、阻力训练和伸展。健康活动奖励(HAPI)干预措施将针对艾滋病毒阳性物质滥用者，并在这些吸毒者中进行测试，这些吸毒者参加艾滋病毒收容中心。在有9名患者参与的1a阶段试点项目的初步治疗开发之后，将对治疗手册和材料进行改编和完善。在Ib阶段对照试验中，我们将招募50名药物滥用HIV阳性患者并将其随机分为(A)HAPI加12步促进疗法或(B)CM戒断加12步促进疗法。每次干预将包括为期16周的每周一次的个人治疗。所有参与者将提供尿液和呼吸样本，每周两次，将进行阿片类药物、兴奋剂、大麻和酒精测试。这两种情况的患者都将有机会因提交药物阴性样本而获奖，那些被随机诊断为Hapi疾病的患者也将有机会因从事健康活动而获奖。将在治疗前、治疗后2个月和4个月(治疗后)以及7个月(治疗后3个月)进行体力活动水平、药物使用、心理症状以及健康的主观和客观指标(体重指数、腰围、血压、病毒载量)的测量。与接受CM戒毒12步促进的患者相比，我们预计处于HAPI状态的患者将参与更多的体育活动，在更大程度上减少药物使用，证据减少抑郁，并显示出健康指数改善的趋势。如果在所有领域都注意到至少在小到中等范围内的效果大小，我们将认为该治疗适合在第二阶段治疗发展研究中进行进一步评估。

DESCRIPTION (provided by applicant): Contingency management (CM) interventions are highly efficacious in enhancing retention in treatment and reducing drug use. Growing evidence suggests these treatments can be adapted to alter a variety of behaviors, including health-related physical activities. Physical activity has beneficial effects on reducing depression and improving health. We have pilot data suggesting that drug abusing patients who engage in exercise to earn reinforcement have improved drug abuse outcomes relative to those who do not engage in exercise during CM treatments. In this Stage 1 therapy development project, we plan to develop, formalize, and derive effect size estimates of a CM therapy that focuses on improving health, especially as related to increasing low intensity physical activities, such as walking, resistance training, and stretching. The Healthy Activities for Prize Incentives (HAPI) intervention will be targeted toward and tested within HIV-positive substance abusers who attend HIV drop-in centers. After initial therapy development in a Stage 1a pilot project with 9 patients, the therapy manuals and materials will be adapted and refined. In a Stage Ib controlled trial, we will recruit and randomize 50 substance abusing HIV-positive patients to (a) HAPI plus 12-step facilitation therapy or (b) CM for abstinence plus 12-step facilitation therapy. Each intervention will consist of one weekly individual therapy session for 16 weeks. All participants will provide urine and breathe specimens twice weekly that will be tested for opioids, stimulants, marijuana and alcohol. Patients in both conditions will earn the chance to win prizes for submitting drug-negative specimens, and those randomized to the HAPI condition will also earn the chance to win prizes for engaging in healthy activities. Physical activity levels, drug use, psychological symptoms, and subjective and objective indicators of health (body mass index, waist circumference, blood pressure, viral load) will be measured pre-treatment and at months 2 and 4 (post- treatment), as well as at a 7-month (3 months after treatment) follow-up evaluation. Compared to that receiving 12-step facilitation with CM for abstinence, we expect that those in the HAPI condition will participate in more physical activities, decrease drug use to a greater extent, evidence reduced depression, and show trends toward improvements in health indices. If effect sizes in at least the small to medium range are noted across all domains, we will consider the therapy appropriate for further evaluation in a Stage 2 therapy development study.